The effects of childhood sexual abuse on health and well-being
One in five women and one in 13 men are thought to be affected by childhood sexual abuse (CSA). Childhood sexual abuse is a violation of fundamental human rights and its impacts have far-reaching consequences that extend to entire communities and economies. This type of violence can contribute to the persistence of poverty and gender inequality, by often affecting a survivor's ability to pursue education and hindering their economic productivity, affecting not only the survivor but also their local network.
Moreover, the harmful effects of CSA can pass down through generations, creating a cycle of suffering and trauma.
Substantial impact on health and well-being
The eradication of childhood sexual abuse and its negative consequences is not just confined to the criminal justice system. There has been an emerging body of evidence suggesting the impacts of CSA can be substantial on an individual's health and well-being.
Globally to date compared to other risk factors on one's health, understanding the impact of CSA on health and health system use has historically been understudied. For example, in the most recent published edition of the Global Burden of Disease (GBD) study (the world's most comprehensive research effort quantifying the impact of various diseases, injuries, and risk factors on human health), CSA is associated with a subsequent increased risk of alcohol abuse disorders and depression to survivors.
For survivors and their advocates, there are countless stories of additional impacts on health which need to urgently be captured and described to inform health care decision making to prioritize the right type of support for survivors.
In a recent study in Nature Medicine, working with experts in the GBD team and at the University of Miami as part of The Lancet Commission on Gender-Based Violence and Maltreatment of Young People, researchers meticulously reviewed over 4,000 research articles and found 229 studies which have enhanced our global understanding of both the health impacts of CSA and intimate partner violence.
Using a novel approach, they evaluated the strength of evidence connecting CSA to 15 health conditions (alcohol use disorders, self-harm, major depressive disorder, anxiety disorders, asthma, type 2 diabetes mellitus, HIV/AIDS, sexually transmitted infections, maternal abortion and miscarriage, drug use disorders, conduct disorder, bulimia nervosa, schizophrenia, anorexia nervosa and ischemic heart disease) which met our strict inclusion criteria.
In particular, the findings with the greatest strength of evidence suggested a moderate association between CSA and an increased risk of alcohol use (45%) and self-harm (35%).
Historically, policymakers have considered that the impacts of CSA may be confined to mental ill health and substance misuse, however this study has outlined that the physical health consequences of abuse are also substantial.
For example, leading to the subsequent develop of conditions such as asthma, which has been confirmed in other recent work, where it was demonstrated that patients with a record of childhood maltreatment (all types of childhood abuse and violence) were 42% more likely to develop asthma.
Despite the breadth of our review, it's crucial to acknowledge that the outcomes presented are likely an underrepresentation of the total health impacts associated with these forms of abuse. The sobering reality remains that CSA continues to be a neglected area within global health research. Despite the alarming associations uncovered, our study also highlights the overall dearth of evidence on CSA, particularly when compared to other risk factors like smoking and high blood pressure.
It's imperative to address this research gap and prioritize violence against children as a crucial component of global health. In response to this work, the investigators anticipate that in a future round of the GBD study to see a greater burden of global illness attributable to CSA.
This in turn will hopefully raise the profile of CSA as a global public health issue and encourage further funding to be dedicated to this field.
Health sector vital
The researchers say that while we work towards advancing the evidence base on the health impacts of CSA, it's essential to recognize that individuals experiencing these forms of violence will continue seeking health services globally. The health sector serves as a vital window of opportunity to intervene in cases of CSA. Integrating interventions to address violence against children into national health policies, with clear protocols and sufficient budget allocations, is essential for effective support and care for survivors.
For example, to mitigate these effects and truly take a public health approach to violence, adopting holistic and family-oriented programs, building resilience in survivors, and implementing evidence-based interventions are critical steps.
These include gender-transformative interventions (promoting gender equality), survivor-centered movements, and multidisciplinary approaches aimed at raising awareness, changing societal norms, providing empowerment, and promoting healthy relationships and adversity-free childhoods.
More information: Cory N. Spencer et al, Health effects associated with exposure to intimate partner violence against women and childhood sexual abuse: a Burden of Proof study, Nature Medicine (2023). DOI: 10.1038/s41591-023-02629-5